Tanking Economy May Mean Kids Suffer More Abuse

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Rates of physical abuse and brain injury among the nation's children have risen significantly in the early 21st century.

Point out that the study could not confirm a causal pathway between macroeconomic conditions and child abuse rates, but it does call for an examination of how society can respond to economic hardship and mitigate the risk to children.

Rates of physical abuse and brain injury among the nation's children have risen significantly in the early 21st century, and the recent economic recession and housing crisis may be a reason why, researchers reported.

Each year between 2000 and 2009, rates of child hospitalizations for physical abuse increased by 0.79% (95% CI 0.13 to 1.44, P=0.02) and admissions for traumatic brain injury rose by 3.1% (95% CI 2.36 to 3.87, P<0.001), according to Joanne N. Wood, MD, of the Children's Hospital of Philadelphia, and colleagues.

Yet this was at a time of falling admission rates for all-cause injuries in children younger than 6 years, with annual decreases of 0.80% (95% CI 0.70 to 0.91, P<0.001), the researchers stated in Pediatrics online.

The authors did note that the study could not confirm a causal pathway between macroeconomic conditions and child abuse rates,but it does call for an examination of how society can respond to economic hardship and mitigate the risk to children.

A report in 2010 suggested that the rate of child abuse cases had been falling during the previous 15 years, possibly because of the healthy economic climate the country had been experiencing.

But when the recession hit, concerns arose that the numbers might begin increasing again, as poverty has been shown to strongly influence child abuse, but the effects of a changing economy have been uncertain.

"Even less is known about the impact of the residential foreclosure crisis, an economic stressor that marked the recent recession, on child maltreatment rates," Wood and colleagues wrote.

To explore these possible links, the researchers analyzed administrative hospital discharge data from 38 hospitals, comparing the results with economic data on unemployment, mortgage delinquency, and forclosure rates in the local metropolitan areas.

Between 2000 and 2009, there were 11,822 hospitalizations for abuse in children younger than 6 years, peaking in 2008.

When the researchers compared rates of abuse according to economic factors, they found that each percentage point rise in the 3-month mortgage delinquency rate was accompanied by a 3.09% rise in hospitalizations for physical abuse in children younger than 6 years (95% CI 0.93 to 5.30, P=0.005) and a 4.84% rise in high-risk traumatic brain injury in children younger than 1 year (95% CI 2.66 to 7.07. P<0.001).

In contrast, a single percentage point increase in the mortgage delinquency rate was associated with a −0.13 (95% CI −0.47 to 0.21, P=0.4) change in all-cause hospitalizations for injury, excluding birth or motor vehicle injuries.

For current foreclosures, a 1% point change over the previous year was associated with a 6.50% rise in abuse (95% CI 1.69 to 11.55, P=0.008) and a 10.21% increase in traumatic brain injury (95% CI 5.56 to 15.06, P<0.001).

Once again, however, there was no significant change in all-cause injury (P=0.6).

"These results suggest that housing concerns were a significant source of stress within communities and a harbinger for community maltreatment rates," the researchers observed.

Parental unemployment was not associated with significant changes in any rates of abuse or injury.

Possible explanations for this lack of association with unemployment included that data on employment do not fully capture the economic picture, with many individuals possibly having abandoned the search for work.

Alternatively, the availability of safety net features such as unemployment benefits and other services may have helped alleviate some of the impact of widespread job loss.

Limitations of the study included a possible lack of generalizability to other communities or to future economic changes, and the increased recent tendency for pediatric trauma cases to be referred to specialized centers.

In addition, the analysis assumed that the associations between injury and economic factors was consistent over time, which was not the case.

The rate of admission for abuse or brain injury was highest in 2008, and it remains to be seen if a subsequent decrease continues and if more or less awareness of the problem has developed with increased exposure.

The researchers concluded that the challenge of maintaining the safety of children and families in times of economic difficulty remains.

Wood's institution has received payment for her expert witness court testimony for suspected child abuse.

The other authors reported no relevant financial conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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